A 65-Year-Old Man Comes to the Office Due to 4

question 292

Multiple Choice

A 65-year-old man comes to the office due to 4 months of worsening fatigue.  The patient feels tired with simple household chores.  He has a 15-pack-year smoking history and drinks 2 or 3 beers daily.  Temperature is 37 C (98.6 F) , blood pressure is 134/86 mm Hg, and pulse is 76/min.  Physical examination reveals a late systolic ejection murmur with a soft S2.  The lungs are clear to auscultation.  The abdomen is soft and nontender with no hepatosplenomegaly.  There are no focal neurological deficits.  Laboratory testing reveals hemoglobin is 9 g/dL and mean corpuscular volume is 93 µm³.  Peripheral blood smear is shown below: Which of the following best explains the observed erythrocyte findings in this patient?

• A)Chronic gastrointestinal blood loss
• B)Excessive cold agglutinin production
• C)Increased serum paraproteins
• D)Mechanical erythrocyte injury
• E)Nutritional vitamin B₁₂ deficiency

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Definitions:

Efficiency

The extent to which resources are used in the most productive way possible to produce desired goods and services while minimizing waste or inefficiency.

Economic Pie

A metaphorical representation of the total wealth or economic resources available for allocation or distribution within an economy.

Average Cost

The total cost of production divided by the quantity produced, indicating the cost per unit of output.

Unlimited Resources

A theoretical scenario where resources are abundant and not finite, eliminating scarcity and its associated challenges.